Insuring Your Health

New health-care law provides free preventive care for many seniors

Network News

Preventive health care is important at any age, but never more so than as we get older. Many of the major cancers that can be screened for -- such as breast and colorectal cancer -- are typically diagnosed at about age 70. After age 55, people have a 90 percent chance of developing high blood pressure, putting them at higher risk for heart disease and stroke.

"The payoff in terms of prevention in geriatrics is more upfront and more immediate," says geriatrician Peter Hollmann, chairman of the public policy committee for the American Geriatrics Society.

Starting in January, the new health-care law will make it easier and cheaper for seniors to get preventive care. Medicare beneficiaries will be able to receive for free all preventive services and screenings that receive an A or B recommendation for seniors from the U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention. These measures include mammograms and colorectal cancer screening, bone mass measurement and nutritional counseling for people at risk for diet-related chronic diseases such as diabetes.

Medicare beneficiaries will also get a free annual wellness visit under the new law. The visit will cover a number of services, including a health risk assessment and a review of the person's functional and cognitive abilities.

The goal is to identify and to address declines in physical or mental capacity early on, say experts -- before someone takes a fall, for example, or starts to forget to pay his bills.

Currently, seniors in traditional Medicare pay 20 percent of the cost for most covered preventive services. The new requirements for free preventive coverage don't apply to enrollees in Medicare Advantage plans, although many of those plans already offer free preventive services.

Cost can be a big stumbling block to getting preventive care.

A co-payment of just $12 for a mammogram in Medicare's managed-care plans resulted in screening rates that were 8 to 11 percentage points lower than those for women in plans that didn't require a co-payment, according to a 2008 study published in the New England Journal of Medicine. Another study found that an increase of $10 in a co-payment for physician office visits led to a 20 percent decline in appointments among elderly patients.

"A lot of these screenings aren't something somebody wakes up and says, 'Wow, I'm going to have a flexible sigmoidoscopy today,' " says Cheryl Matheis, senior vice president for health strategy at AARP.

To encourage seniors to get that test, one of a number of approved screenings for colorectal cancer, and other important preventive services, "we have to educate people about the value and then eliminate the cost and make it convenient," she says.

The new law envisions the free annual wellness visit as an opportunity for seniors to develop a "personalized prevention plan" with their physician and plot out appropriate services and screenings for the next five to 10 years.

There hasn't been much research on people in their 80s or older, so it's hard to calculate the risk/benefit ratio of preventive tests and screenings in this group, say experts.